Provider Demographics
NPI:1912013442
Name:GRANGE, CLAUDINE NANCY (NP)
Entity Type:Individual
Prefix:MS
First Name:CLAUDINE
Middle Name:NANCY
Last Name:GRANGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3719
Mailing Address - Country:US
Mailing Address - Phone:207-874-9620
Mailing Address - Fax:
Practice Address - Street 1:9 OLD SAWMILL LN
Practice Address - Street 2:
Practice Address - City:ARUNDEL
Practice Address - State:ME
Practice Address - Zip Code:04046-8164
Practice Address - Country:US
Practice Address - Phone:207-985-8998
Practice Address - Fax:207-985-1281
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER048206363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health